Coronary disease & ACS

Comparison of Photon-Counting and Energy-Integrating Computed Coronary Tomography Angiography for Coronary Artery Disease: A Systematic Review and Meta-Analysis

JACC Cardiovasc ImagingPublished Systematic review and meta-analysis

Authors' conclusion

Compared against conventional EID-CT, PCD-CT was associated with down-classification of stenosis severity, translating to fewer referrals for ICA and a greater rate of revascularization when angiography is undertaken.

Study context

Population
Adults with stable CAD undergoing coronary computed tomography angiography (CTA)
Participants
11,350 adults15 studies
Comparison
PCD-CT vs EID-CT coronary CTA
Outcome
Vessel-level stenosis reclassification, downstream invasive coronary angiography (ICA) referral, and revascularization rates among those referred
Methodological detailspreregistered protocol, PRISMA 2020, random-effects
  • Preregistered protocol
  • PRISMA 2020
  • Random-effects

Pooled result

As reported in the abstract

PCD-CT vs EID-CTOdds ratio (95% CI)P value
Downstream ICA referral
0.71(0.63–0.79)
P < 0.0001
Revascularization among those undergoing ICA
1.43(1.14–1.79)
P = 0.0017
Vessels with stenosis down-classified
pooled absolute proportion 34.2% (95% CI 27.3–41.9); P < 0.0001

Further pooled results

OutcomeOR (95% CI)P value
ICA referral, by CACS (subgroup)PCD-CTvs EID-CTCACS <4000.62 (0.52–0.75)P < 0.0001
ICA referral, by CACS (subgroup)PCD-CTvs EID-CTCACS ≥4000.42 (0.16–1.11)P = 0.08

Original publication

Comparison of Photon-Counting and Energy-Integrating Computed Coronary Tomography Angiography for Coronary Artery Disease: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. Published 18 July 2026. doi:10.1016/j.jcmg.2026.05.021

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